Predictors for treatment outcomes among patients with drug-susceptible tuberculosis in the Netherlands: a retrospective cohort study

ObjectivesWe evaluated treatment outcomes and predictors for poor treatment outcomes for tuberculosis (TB) among native- and foreign-born patients with drug-susceptible TB (DSTB) in the Netherlands.MethodsThis retrospective cohort study included adult patients with DSTB treated from 2005 to 2015 from a nationwide exhaustive registry. Predictors for unsuccessful treatment outcomes (default and failure) and TB-associated mortality were analysed using multivariate logistic regression.ResultsAmong 5,674 identified cases, the cumulative incidence of unsuccessful treatment and mortality were 2.6% (n/N = 146/5,674) and 2.0% (112/5,674), respectively. Although most patients were foreign-born (71%; 4,042/5,674), no significant differences in these outcomes were observed between native- and foreign-born patients (p > 0.05). Significant predictors for unsuccessful treatment were age of 18–24 years [odds ratio (OR), 2.04; 95% confidence interval (CI): 1.34–3.10], homelessness (OR, 2.56; 95% CI: 1.16–5.63), prisoner status (OR, 5.39; 95% CI: 2.90–10.05) and diabetes (OR, 2.02; 95% CI: 1.03-3.97). Furthermore, predictors for mortality were age of 74–84 (OR, 5.58; 95% CI: 3.10–10.03) or ≥85 years (OR, 9.35, 95% CI: 4.31–20.30), combined pulmonary and extra-pulmonary TB (OR, 4.97; 95% CI: 1.42–17.41), central nervous system (OR, 120, 95% CI: 34.43–418.54) or miliary TB (OR, 10.73, 95% CI: 2.50–46.02), drug addiction (OR, 3.56; 95% CI: 1.34–9.47) and renal insufficiency/dialysis (OR, 3.23; 95% CI: 1.17–8.96).ConclusionsNative- and foreign-born patients exhibited similar TB treatment outcomes. To further reduce disease transmission and inhibit drug resistance, special attention should be given to high-risk patients.